Percutaneous Tracheostomy With a Demistifier Canopy in the COVID-19 Era: A Safe Technique in the Intensive Care Unit

BACKGROUND

Endoscopic percutaneous tracheostomy (PT) is a safe technique that is performed frequently by otolaryngologists and intensivists. New challenges have been identified in order to maintain the safety of this procedure during the COVID-19 pandemic. A novel approach, using a modified demistifier canopy, was developed during the first wave of the pandemic and implemented for 17 consecutive percutaneous tracheostomies in order to enhance procedural safety.

METHODS

A protocol was developed after performing a literature review of tracheostomy in COVID-19 patients. A multidisciplinary tracheostomy team was established, including the departments of otolaryngology, critical care, and respiratory therapy. Simulation was performed prior to each PT, and postoperative debriefings were done.

RESULTS

A protocol and technical description of PT using a modified demistifier canopy covering was written and video documented. Data were collected on 17 patients who underwent this procedure safely in our tertiary care hospital. There were no procedure-related complications, and no evidence of COVID-19 transmission to any member of the health care team during the study period.

CONCLUSION

As patients continue to recover from COVID-19, their need for tracheostomy will increase. The technique described provides a safe, multidisciplinary method of performing PT in COVID-19 patients.

A Prosocial Scale for the Preschool Behaviour Questionnaire: Concurrent and Predictive Correlates

The Preschool Behaviour Questionnaire has been used widely to assess children's aggressive, anxious, and hyperactive behaviour. Items from the Prosocial Behaviour Questionnaire were added to create a prosocial scale. The resulting questionnaire was administered to teachers of three large samples of kindergarten children and shown to have three stable, orthogonal components disruptive (13 items): anxious (6 items); and prosocial (10 items). Mother and peer assessments of children were used to investigate concurrent and predictive validity. Concurrent data showed that the disruptive component was highly correlated with peer assessments and moderately correlated with mother assessments; the prosocial component was moderately correlated with peer assessments but marginally correlated with mother assessments, whereas the anxious component was marginally correlated with peer assessments and moderately correlated with mother assessments. From a predictive perspective it was shown that highly disruptive boys in kindergarten who were prosocial, were assessed by mothers and teachers at age 9 to be better adjusted than highly disruptive boys in kindergarten who were non-prosocial.

Different sites of xenoantigen delivery lead to a virally induced late-onset hepatitis in mice through molecular mimicry

BACKGROUND

Epidemiological and laboratory evidences led to the hypothesis that molecular mimicry between viruses and self-proteins could be linked to the onset of autoimmune hepatitis (AIH). Hepatotropic viruses could be good candidates, as a pro-inflammatory environment may facilitate the development of AIH.

AIMS

The aims of this study were to test a virus ability to induce an AIH through molecular mimicry and the influence of hepatic inflammation in this process.

METHODS

C57BL/6 mice were injected i.v. or i.m. with recombinant adenoviral vectors (RecAdV) encoding for human type 2 AIH antigens to target xenoantigens expression in the liver and to create a transient hepatitis (i.v.) or for 'peripheral' xenoantigens expression (i.m.). Liver injury and B-cell response were evaluated.

RESULTS

Late-onset hepatitis was observed 8 months after i.v. or i.m. RecAdV injections, despite presence or absence of an initial transient hepatitis. Intensity of B-cell response was similar for both type of injections, but the Ig isotypes produced were different. B-cell autoimmune response spread to several liver proteins.

CONCLUSIONS

Liver autoimmune response can be initiated using molecular mimicry over a long period of time, validating the hit-and-run hypothesis. Initial liver inflammatory injury is neither necessary, nor detrimental to the development of AIH. These results highlight the significance of initial events on the pathogenesis of autoimmune liver injury.

A novel gene cluster in Fusarium graminearum contains a gene that contributes to butenolide synthesis

The development of expressed sequence tag (EST) databases, directed transformation and a sequenced genome has facilitated the functional analysis of Fusarium graminearum genes. Extensive analysis of 10,397 ESTs, derived from thirteen cDNA libraries of F. graminearum grown under diverse conditions, identified a novel cluster of eight genes (gene loci fg08077-fg08084) located within a 17kb region of genomic sequence contig 1.324. The expression of these genes is concomitantly up-regulated under growth conditions that promote mycotoxin production. Gene disruption and add-back experiments followed by metabolite analysis of the transformants indicated that one of the genes, fg08079, is involved in butenolide synthesis. The mycotoxin butenolide is produced by several Fusarium species and has been suggested, but not proven, to be associated with tall fescue toxicoses in grazing cattle. This is the first report of the identification of a gene involved in the biosynthetic pathway of butenolide.

Expression of cyclo-oxygenase-2 in naturally occurring squamous cell carcinomas in dogs

Squamous cell carcinoma is one of the most common cancers in humans and is also a frequently diagnosed neoplasm in dogs. Induction of cyclo-oxygenase-2 (COX-2), a key rate-limiting enzyme in prostaglandin biosynthesis, has been implicated in the oncogenesis of various cancers in humans, including squamous cell carcinomas. However, expression of COX-2 has not been reported in spontaneous squamous cell carcinomas of non-human species. Canine squamous cell carcinomas share several similarities with the human disease. Therefore, the objective of this study was to determine whether COX isoenzymes were expressed in naturally occurring cases of squamous cell carcinomas in dogs. Canine normal skin (n=4) and squamous cell carcinomas (n=40) were studied by immunohistochemistry and immunoblotting analysis using polyclonal antibodies selective for COX-1 or COX-2. COX-2 was strongly expressed by neoplastic keratinocytes in all cases of squamous cell carcinomas, whereas no COX-2 was detected in normal skin and in the non-neoplastic skin and oral mucosa included in the tumor tissue samples (p<0.01). Immunoblotting analysis confirmed the restricted expression of COX-2 (72,000--74,000 molecular weight doublet) in squamous cell carcinomas only. In contrast, faint COX-1 staining was found in normal skin and in squamous cell carcinomas. This study demonstrates for the first time that COX-2 is induced in canine squamous cell carcinomas, and provides a new model to investigate the role and regulation of COX-2 gene expression in naturally occurring squamous cell carcinomas. (J Histochem Cytochem 49:867-875, 2001)

Proximate effects of a child sexual abuse prevention program in elementary school children

OBJECTIVE

The effects of the sexual child abuse prevention program ESPACE were evaluated by means of a Solomon-type design with first and third grade children. ESPACE is an adaptation of the American Child Assault Prevention Program (CAP). Possible side effects of the program were also examined.

METHOD

A total of 133 children (64 first-graders and 69 third-graders) participated in the study. Children completed a knowledge questionnaire and a video vignette measure designed to evaluate preventive skills towards abusive and potentially abusive situations. A follow-up measure (2 months) was administered to verify whether knowledge and skills were maintained.

RESULTS

Results indicated that children participating in the prevention program showed greater preventive knowledge and skills relative to children not participating. Follow-up data showed that knowledge gains were maintained while the preventive skill gains may attenuate. However, while global skill scores decreased between post-test and follow-up, children still showed greater preventive skills at follow-up than before the program. In terms of unanticipated side effects, results revealed that almost half of the parents noted positive reactions following children's participation in the ESPACE program. Furthermore, the majority of parents did not identify negative reactions in their children following their participation in the workshop.

CONCLUSION

The findings suggest that the Quebec adaptation of the CAP program was effective in training children in abuse prevention concepts and skills.

Coping strategies and social support as mediators of consequences in child sexual abuse victims

OBJECTIVE

The main objective of this study was to evaluate the mediator role of coping strategies and social support on the adaptation of children following CSA. Empirical studies indicate that short-term consequences of child sexual abuse (CSA) are multiple and varied (Kendall-Tackett, Williams, & Finkelhor, 1993; Wolfe & Birt, 1995). While abuse-related characteristics were first studied to explain the variability of CSA outcome, more recently, the influence of other variables such as coping strategies and social support have been considered.

METHOD

Fifty sexually abused children aged between 7 and 12 participated in this study. The Child Behavior Checklist (Achenbach, 1991) and the Perceived Competence Scale for Children (Harter, 1985) were used to measure victims' adjustment. Coping strategies were evaluated by the Self-Report Coping Scale (Causey & Dubow, 1992) and the children completed the Perceived Social Support (Harter, 1985). A French version of the History of Victimization (Wolfe, Gentile, & Bourdeau, 1987) was used to gather abuse-related characteristics from medical records.

RESULTS

Results indicate that sexually abused children exhibit internalizing and externalizing behavior problems following CSA. Coping strategies and social support exert direct effects on victims' adjustment instead of the mediator influences originally expected. Among abuse-related variables, only the perpetrator's identity is directly related to internalizing symptoms.

CONCLUSIONS

The absence of mediational effects of coping and social support is discussed in light of the measures used and the cross-sectional nature of the study. Results highlight the importance of parental implication and the consideration of coping strategies in designing therapeutic interventions with this population.

Epidemiological study of parasite infection in a cow-calf beef herd in Quebec

The patterns of gastrointestinal and pulmonary nematode infections in a previously untreated Aberdeen Angus cow-calf herd were observed between May 1988 and December 1990. The cow-calf herd and replacement heifers were on separate pastures. The relatively high mean faecal egg counts of cows and heifers at the time of turnout were mainly owing to the maturation of hypobiotic worms. The strongyle egg counts of calves began to rise soon after turnout onto pasture and reached peak levels at the end of the grazing season. The number of infective larvae on pasture was highest during September/October. Ostertagia, Cooperia and Nematodirus were the most prevalent genera found at necropsy and on pasture. Larvae of these nematodes were able to overwinter on pasture and Ostertagia larvae, additionally, were able to overwinter in the host as arrested early fourth stage larvae. The high egg output of cows at the time of turnout may serve as a source of infection for their calves and be responsible for the late-season rise in pasture larval counts.

[The child and his family : some new research topics.]

The aim of the article is to demonstrate the ever-increasing interest of genetic psychology in the multi-variate analysis of the numerous factors in psychological development. Going beyond the mother-child relation, researchers are turning, more and more, towards physical and family milieu social factors, factors directly linked to the child and forms of family-child adjustment, and this, as much within the context of socio-affective development as that of cognitive development. What is presented is not an exhaustive survey of documentation, but rather an introduction to new, particularly promising, avenues of research.